Provider Demographics
NPI:1508600685
Name:WANG, JUSTIN S
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:S
Last Name:WANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:574 4TH AVE APT 9C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-6366
Mailing Address - Country:US
Mailing Address - Phone:571-529-2563
Mailing Address - Fax:
Practice Address - Street 1:574 4TH AVE APT 9C
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-6366
Practice Address - Country:US
Practice Address - Phone:571-529-2563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health